Sustainable Development Goals summit 2023 and the global pledge on disability-focused early childhood development
Authors: Bolajoko O Olusanya, Vivian G Cheung, Mijna Hadders-Algra, Cecilia Breinbauer, Tracey Smythe, Marisol Moreno-Angarita, Sally Brinkman, Nihad Almasri, Marta Figueiredo, Olaf Kraus de Camargo, Ike Chinonye Nnanna, Sandra S Block, Claudine Storbeck, Jacob O Olusanya, Brad D Berman, Donald Wertlieb, Andrew N Williams, M K C Nair, Adrian C Davis, Scott M Wright
Journal: The Lancet Global Health (2023)

In September, 2023, the second global summit on the Sustainable Development Goals (SDGs) will be held during the annual UN General Assembly for the midpoint appraisal of the 2015–30 Agenda for Sustainable Development.1UNResolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development.http://www.un.org/ga/search/viewdoc.asp?symbol=A/RES/70/1&Lang=EDate: 2015Date accessed: March 15, 2023Google Scholar The summit will review the global progress in implementing the SDGs, consider new challenges that arose since 2015, provide updated policy guidance, and mobilise action to accelerate progress towards achieving the SDGs. This occasion provides a rare and timely opportunity to review the global commitment on early childhood development (ECD) for children younger than 5 years, and to leave no one behind (SDG 4.2). Optimal ECD is foundational to the lifelong wellbeing of all children and for ensuring a fulfilling and healthy life.2UN Department of Economic and Social AffairsWorld social report 2023: leaving no one behind in an ageing world.https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2023/01/2023wsr-fullreport.pdfDate: 2023Date accessed: March 15, 2023Google Scholar The global vision and commitment for ECD is to optimise school readiness for inclusive and equitable quality education for the most disadvantaged and marginalised children, especially for disabled children.1UNResolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development.http://www.un.org/ga/search/viewdoc.asp?symbol=A/RES/70/1&Lang=EDate: 2015Date accessed: March 15, 2023Google Scholar Although several pledges had been made to address the needs of disabled children before 2015 (panel), SDG 4 is the first and only explicit global pledge to implement ECD in low-income and middle-income countries. This commitment was embodied in the overall global education agenda but the role of the health sector in promoting children's overall wellbeing and psychosocial development from birth until school entry was duly acknowledged.1UNResolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development.http://www.un.org/ga/search/viewdoc.asp?symbol=A/RES/70/1&Lang=EDate: 2015Date accessed: March 15, 2023Google Scholar In preparation for the launch of the SDGs, UNESCO, as the specialised global agency for education, articulated an action plan for implementing SDG 4 in partnership with other relevant UN agencies, but apparently excluded WHO.3UNESCOEducation 2030: Incheon declaration and framework for action for the implementation of Sustainable Development Goal 4: ensure inclusive and equitable quality education and promote lifelong learning.https://uis.unesco.org/sites/default/files/documents/education-2030-incheon-framework-for-action-implementation-of-sdg4-2016-en_2.pdfDate: 2016Date accessed: March 15, 2023Google Scholar The action plan for ECD and early care focused on preschool education and overlooked the importance of early detection of developmental disabilities and intervention for disabled children. In 2018, the Nurturing Care Framework was launched by WHO, UNICEF, and the World Bank as an independent global ECD initiative without inputs from UNESCO.4UNICEFWHONurturing care practice guide: strengthening nurturing care through health and nutrition services.https://www.who.int/publications/i/item/9789240058651Date: 2022Date accessed: March 15, 2023Google Scholar The Nurturing Care Framework was, therefore, not explicitly linked to the global commitment on inclusive education for all children younger than 5 years under SDG 4. Rather, this framework primarily focuses on health-related issues in the first 1000 days from conception. Both WHO and UNICEF have now developed separate tools for ECD monitoring, namely: the Global Scale for Early Development for children aged 0–3 years, and the Early Childhood Development Index 2030 for children aged 2–5 years. Although efforts to combine these tools are ongoing, neither of these tools is designed for identifying all children younger than 5 years with disabilities for early and appropriate intervention as envisioned under SDG 4.2.5Olusanya BO Gulati S Newton CRJ The Nurturing Care Framework and children with developmental disabilities in LMICs.Pediatrics. 2023; (published online March 7.)https://doi.org/10.1542/peds.2022-056645Crossref PubMed Scopus (6) Google ScholarPanelHighlights of global pledges and resolutions for disabled children1946: UNICEF Mission Statement"UNICEF is non-partisan, and its cooperation is free of discrimination. In everything it does, the most disadvantaged children and the countries in greatest need have priority."1990: The UN Convention on the Rights of the Child"Recognizing the special needs of a disabled child, assistance shall be provided free of charge, whenever possible, taking into account the financial resources of the parents or others caring for the child, and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities in a manner conducive to the child's achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development." [Article 23]2002: Special UN Resolution on A World Fit for Children"We will take all measures to ensure the full and equal enjoyment of all human rights and fundamental freedoms, including equal access to health, education and recreational services, by children with disabilities and children with special needs; to ensure the recognition of their dignity; to promote their self-reliance; and to facilitate their active participation in the community." [Plan of Action, A:21]2006: The UN Convention on the Rights of Persons with Disabilities"Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons." [Article 25]2011: The WHO World Report on Disability"Where there are none, or only limited, services introduce minimum services within existing health and social service provision to include: developing basic rehabilitation services within the existing health infrastructure, strengthening rehabilitation service provision through community-based rehabilitation, and prioritizing early identification and intervention strategies using community workers and health personnel." [Recommendations on Service Delivery]2013: The Resolution of the World Health Assembly on Disability"Request WHO to provide technical assistance to Member States to promote habilitation and rehabilitation across the life course and for a wide range of health conditions through: early intervention; integrated and decentralized rehabilitation services, including mental health services; improved provision of wheelchairs, hearing aids, low vision devices and other assistive technologies; and training to ensure that there is a sufficient supply of rehabilitation professionals to enable people with disabilities to achieve their potential and have the same opportunities to participate fully in society." [WHA66.9 Disability, Resolution 2(6)]2013: The UNICEF State of the World's Children"Reliable and objective data are important to assist in planning and resource allocation, and to place children with disabilities more clearly on the development agenda. The necessary statistical work will take time but would be given vital impetus, were international donors to promote a concerted global research agenda on disability. In the meanwhile, planning and programming will have to continue; denying or delaying services to children with disabilities because more data are needed would be unacceptable. Rather, plans, programmes and budgets can be designed to allow for modifications as additional information is made available." [Global Promise, p 85].2015: UN SDG"Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.•Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care, and pre-primary education so that they are ready for primary education.•Indicator 4.2.1: Proportion of children under 5 years of age [revised in 2021 as "aged 24–59 months"] who are developmentally on track in health, learning and psychosocial well-being, by sex." 1946: UNICEF Mission Statement "UNICEF is non-partisan, and its cooperation is free of discrimination. In everything it does, the most disadvantaged children and the countries in greatest need have priority." 1990: The UN Convention on the Rights of the Child "Recognizing the special needs of a disabled child, assistance shall be provided free of charge, whenever possible, taking into account the financial resources of the parents or others caring for the child, and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities in a manner conducive to the child's achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development." [Article 23] 2002: Special UN Resolution on A World Fit for Children "We will take all measures to ensure the full and equal enjoyment of all human rights and fundamental freedoms, including equal access to health, education and recreational services, by children with disabilities and children with special needs; to ensure the recognition of their dignity; to promote their self-reliance; and to facilitate their active participation in the community." [Plan of Action, A:21] 2006: The UN Convention on the Rights of Persons with Disabilities "Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons." [Article 25] 2011: The WHO World Report on Disability "Where there are none, or only limited, services introduce minimum services within existing health and social service provision to include: developing basic rehabilitation services within the existing health infrastructure, strengthening rehabilitation service provision through community-based rehabilitation, and prioritizing early identification and intervention strategies using community workers and health personnel." [Recommendations on Service Delivery] 2013: The Resolution of the World Health Assembly on Disability "Request WHO to provide technical assistance to Member States to promote habilitation and rehabilitation across the life course and for a wide range of health conditions through: early intervention; integrated and decentralized rehabilitation services, including mental health services; improved provision of wheelchairs, hearing aids, low vision devices and other assistive technologies; and training to ensure that there is a sufficient supply of rehabilitation professionals to enable people with disabilities to achieve their potential and have the same opportunities to participate fully in society." [WHA66.9 Disability, Resolution 2(6)] 2013: The UNICEF State of the World's Children "Reliable and objective data are important to assist in planning and resource allocation, and to place children with disabilities more clearly on the development agenda. The necessary statistical work will take time but would be given vital impetus, were international donors to promote a concerted global research agenda on disability. In the meanwhile, planning and programming will have to continue; denying or delaying services to children with disabilities because more data are needed would be unacceptable. Rather, plans, programmes and budgets can be designed to allow for modifications as additional information is made available." [Global Promise, p 85]. 2015: UN SDG "Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. •Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care, and pre-primary education so that they are ready for primary education.•Indicator 4.2.1: Proportion of children under 5 years of age [revised in 2021 as "aged 24–59 months"] who are developmentally on track in health, learning and psychosocial well-being, by sex." The landmark report by UNICEF in 2022, on the state of the world's disabled children,6UNICEFSeen, counted, included: using data to shed light on the well-being of children with disabilities.https://data.unicef.org/resources/children-with-disabilities-report-2021/Date: 2021Date accessed: March 15, 2023Google Scholar and other reports,7Olusanya BO Kancherla V Shaheen A Ogbo FA Davis AC Global and regional prevalence of disabilities among children and adolescents: analysis of findings from global health databases.Front Public Health. 2022; 10977453Crossref Scopus (13) Google Scholar have highlighted the potential effect of the misalignment in institutional and donors' priorities, and programmes for ECD.6UNICEFSeen, counted, included: using data to shed light on the well-being of children with disabilities.https://data.unicef.org/resources/children-with-disabilities-report-2021/Date: 2021Date accessed: March 15, 2023Google Scholar, 7Olusanya BO Kancherla V Shaheen A Ogbo FA Davis AC Global and regional prevalence of disabilities among children and adolescents: analysis of findings from global health databases.Front Public Health. 2022; 10977453Crossref Scopus (13) Google Scholar Approximately 240 million children and adolescents are estimated to have moderate-to-severe disabilities globally,6UNICEFSeen, counted, included: using data to shed light on the well-being of children with disabilities.https://data.unicef.org/resources/children-with-disabilities-report-2021/Date: 2021Date accessed: March 15, 2023Google Scholar and about 50 million children younger than 5 years have mild-to-severe disabilities requiring some form of intervention, such as sensory impairments, intellectual disability, epilepsy, cerebral palsy, autism spectrum disorder, or attention-deficit hyperactivity disorder.7Olusanya BO Kancherla V Shaheen A Ogbo FA Davis AC Global and regional prevalence of disabilities among children and adolescents: analysis of findings from global health databases.Front Public Health. 2022; 10977453Crossref Scopus (13) Google Scholar Compared with children without disabilities, disabled children are more likely to have respiratory tract infections, undernourishment, and show substantially poorer foundational reading and numeracy skills.6UNICEFSeen, counted, included: using data to shed light on the well-being of children with disabilities.https://data.unicef.org/resources/children-with-disabilities-report-2021/Date: 2021Date accessed: March 15, 2023Google Scholar These children are also more likely to experience social and educational exclusion, bullying, and psychosocial trauma. The available data provide unequivocal evidence that children with disabilities are most unlikely to be adequately served by 2030 without immediate and accelerated action.8Olusanya BO Boo NY Nair MKC et al.Accelerating progress on early childhood development for children under 5 years with disabilities by 2030.Lancet Glob Health. 2022; 10: e438-e444Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar After years of neglect, the SDGs ushered expectations of wellbeing and optimal developmental trajectory for the growing group of beneficiaries of the global investments to reduce child mortality.8Olusanya BO Boo NY Nair MKC et al.Accelerating progress on early childhood development for children under 5 years with disabilities by 2030.Lancet Glob Health. 2022; 10: e438-e444Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar The global commitment to inclusive education was, at the time, reassuring for low-income and middle-income countries. However, little progress has been seen in implementing the commitment for disabled children and to leave no one behind.1UNResolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development.http://www.un.org/ga/search/viewdoc.asp?symbol=A/RES/70/1&Lang=EDate: 2015Date accessed: March 15, 2023Google Scholar A comprehensive, multisectoral, well coordinated, and disability-focused strategy to implement ECD for disabled children younger than 5 years, as envisioned under the SDGs, is long overdue to stimulate and support country-led activities.5Olusanya BO Gulati S Newton CRJ The Nurturing Care Framework and children with developmental disabilities in LMICs.Pediatrics. 2023; (published online March 7.)https://doi.org/10.1542/peds.2022-056645Crossref PubMed Scopus (6) Google Scholar, 8Olusanya BO Boo NY Nair MKC et al.Accelerating progress on early childhood development for children under 5 years with disabilities by 2030.Lancet Glob Health. 2022; 10: e438-e444Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar This strategic initiative requires visionary global leadership, effective governance, and substantial global investments to accelerate local capacity-building for delivering routine screening, diagnostic and family-centred rehabilitative services for disabled children in low-income and middle-income countries.9Olusanya BO Davis AC Hadders-Algra M Wright SM Global investments to optimise the health and wellbeing of children with disabilities: a call to action.Lancet. 2023; 401: 175-177Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 10Olusanya BO Gulati S Berman BD et al.Global leadership is needed to optimize early childhood development for children with disabilities.Nat Med. 2023; (published online April 13.)https://doi.org/10.1038/s41591-023-02291-xCrossref PubMed Scopus (4) Google Scholar Unfulfilled commitments by those with the power and resources to act, not only adversely affect the lives, health, and lifetime opportunities of the target beneficiaries, but also undermine trust and confidence in any future pledges, plans, and programmes. Since the Nurturing Care Framework is the sole and overriding global ECD priority for WHO and UNICEF, but unfortunately is not geared towards inclusive and equitable education as mandated by the SDGs, the forthcoming mid-term review provides a unique opportunity to re-affirm the global commitment on ECD and restore trust among the target beneficiaries. MM-A reports grants from UNICEF Colombia. MF reports voluntary leadership roles at HundrED, as an advisory and academy board member. MH-A reports receiving royalties on books on developmental neurology from Mac Keith Press, Kohlhammer, and Taylor and Francis; and payments, honoraria, and travel support for giving lectures on neurodisability at several universities. SSB reports consultancy fees from Special Olympics International, ending in July, 2022; support from the World Council of Optometry for travel to represent the organisation; and voluntary leadership roles at the World Council of Optometry and VISION2020 USA. All other authors declare no competing interests.